Researchers examined the relationship between social determinants of health and experiences of discrimination reported by transgender people in Virginia. Using data collected from 350 self-identified transgender individuals in a 2005-2006 survey, the Virginia Transgender Health Initiative Study, the researchers identified gaps in health care access, among other things, affecting transgender Virginians.

To launch the original survey, a statewide Transgender Taskforce was formed. The Taskforce worked to increase involvement of the transgender community at all levels of study design and implementation. Participants were invited to complete a survey, on-line or with paper and pencil, asking them about demographic information, gender transition, health care experiences, violence, HIV serostatus, substance use health behaviors, interpersonal factors, and experiences of discrimination.

Key Findings:

Among those respondents who had a regular primary-care provider (PCP), 15% said they were “uncomfortable” or “very uncomfortable” discussing transgender-specific health care needs with their provider, and 20% said they had to educate their PCP about their health care needs.

Over 40% of respondents reported experiences of transgender-related discrimination in one or more areas, including health care, employment, and housing.

Over 30% of respondents reported having families who were “not at all” or “not very” supportive of their transgender status, gender expression, or both.

Over 25% of respondents reported experiencing violence as adolescents or adults.

Over 25% of respondents reported needing - but not being able to access - at least one transgender-specific service in the prior 12 months.

Analysis:

Transgender individuals face significant barriers to quality health care, resulting in poor health outcomes and quality of life. Findings from this study reinforce the argument that discrimination against transgender populations occurs at multiple levels of society, not just between individuals, and thus efforts to promote transgender health must be developed with a ‘social determinants’ perspective – i.e. addressing factors beyond just health services, such as legal and economic policies that affect transgender people’s access to housing, employment, educational opportunity, and justice.

The authors argue that, given a lack of legal protections for transgender people in the United States, policies to prevent discrimination are key. Health care was the most common area in which study respondents reported experiencing discrimination – even more than in employment or housing. Lack of provider training and lack of transgender-friendly health care services contribute greatly to poor health outcomes for transgender communities. The researchers concluded that transgender patients who ‘come out’ to their regular PCP too often run a risk for experiencing subsequent discrimination, hostility, or insensitivity, thus undermining their trust in health care services. The researchers call for future studies to examine patient-provider relationships to better understand the experiences of transgender people with their health care providers.

The authors concluded that “public health strategies could be developed to intervene and ameliorate social and environmental influences that negatively affected the population’s health.”[1]

Sexuality educators are uniquely positioned to help the general public understand gender identity and see the connection between gender-identity-based discrimination and poor health outcomes. They can use the results of the Virginia Transgender Health Initiative Study to build the capacity of the U.S. health care system to serve transgender patients - for just one example, by advocating for medical schools to provide sexuality education for medical students that includes the topic of gender identity.

Sexuality educators can also use these findings to educate others on why improved health care services alone will not be enough to sustain gains in transgender health. As demonstrated by the authors, better policies in housing, employment, and educational opportunity will still be needed to ensure long-term wellness in transgender communities.